About 95% of the scrofula cases in adults are caused by Mycobacterium tuberculosis, most often in immunocompromised patients (about 50% of cervical tuberculous lymphadenopathy).

The fatal outcome some patients experienced in earlier times was due to a cheese-like presentation of the lungs and the King's Evil lesions.

However it is vital that, on a case-by-case basis, it is determined whether the cause is tuberculous or nontuberculous mycobacteria, as treatment often differs between the two forms.

[5] King's Evil, as the disease was historically called, was known as a frequent disorder in the 17th century, and was believed to be caused by bad blood coagulating in spongy organs such as the thyroid and the lymph nodes.

[6] The treatment for mycobacterial cervical lymphadenitis consisted primarily of small incisions to remove the surrounding soft tissue and/or the abnormal mass.

In both France and England, the kings, who were thought to have inherited a miraculous power to cure the illness, touched crowds of infected people.

[8] At age three the English lexicographer Samuel Johnson, for example, was treated for scrofula in this way, touched by Queen Anne and presented with a piece of gold, unfortunately, to no effect.

The cocktail-drug treatment of tuberculosis (and inactive meningitis) includes rifampicin along with pyrazinamide, isoniazid, ethambutol, and streptomycin ("PIERS").

[citation needed] The affected nodes can be removed either by repeated aspiration, curettage or total excision (with the risk in the latter procedure, however, often causing unsightly scarring, damage to the facial nerve, or both).

Physicians, healers, and patent medicine sellers offered a wide range of cures for scrofula or the King's Evil.

Since ancient times, the highly toxic heavy metal mercury, referred to as cinnabar, quicksilver or calomel, was administered as an ointment or pill or inhaled as a vapor to treat skin diseases.

In 1830, the New-York Medical and Physical Journal continued to recommend mercury as the best cure for scrofula, stating it caused an irritation that would counteract the disease and increased the working of the glands.

The patient was admitted to the hospital after tuberculosis skin test became positive and further examination showed several other enlarged lymph nodes near her neck.

Bacterial cultivation of tissue from the excised lymph node resulted in the growth of "atypical Mycobacteria", which were identified by 16S gene sequencing as Mycobacterium florentinum.